Double Vision as a Side Effect of Apalutamide
Double vision (diplopia) is not listed among the documented side effects of apalutamide in clinical trials or FDA-approved guidelines.
Known Side Effects of Apalutamide
Based on high-quality evidence from clinical trials, the most common adverse events associated with apalutamide include:
- Fatigue (30.4% vs 21.1% in placebo) 1
- Hypertension (24.8% vs 19.8%) 1
- Rash (23.8% vs 5.5%) 1
- Diarrhea (20.3% vs 15.1%) 1
- Nausea (18.1% vs 15.8%) 1
- Weight loss (16.1% vs 6.3%) 1
- Arthralgia (15.9% vs 7.5%) 1
- Falls (15.6% vs 9.0%) 1
Neurological and Visual Side Effects
While diplopia is not specifically mentioned, apalutamide has been associated with some neurological effects that could potentially affect vision:
- Dizziness (9.3% vs 6.3% in placebo) 1
- Mental-impairment disorders (5.1% vs 3.0%) 1
- Seizure (0.2% vs 0%) 1
Clinical Implications
If a patient on apalutamide reports double vision:
- Consider that this may be an uncommon or unreported side effect 1
- Evaluate for other potential causes of diplopia, as it has many neurological and ophthalmological etiologies 1
- Consider whether dizziness, a known side effect of apalutamide, might be contributing to visual disturbances 1
- Rule out other medication interactions, as apalutamide is metabolized by CYP2C8 and CYP3A4 enzymes 2
Monitoring and Management
For patients experiencing visual disturbances while on apalutamide:
- Document the onset, pattern, and severity of diplopia 1
- Perform a complete ophthalmological examination to rule out other causes 1
- Consider temporary dose reduction or discontinuation if symptoms are severe 1
- Monitor for improvement after medication adjustment 1
Conclusion
Based on the comprehensive evidence from the SPARTAN trial and other studies, diplopia is not among the reported side effects of apalutamide. However, clinicians should remain vigilant for unusual adverse effects and report any potential new side effects to regulatory authorities 1.